Fatty Liver (cont.)
In this Article
What are the symptoms of NAFLD and NASH?
The symptoms of NAFLD and NASH are
identical. They are very bland (not dramatic) and non-specific (can also be
observed in other diseases). They can occur at any adult age and, in children,
usually appear after 10 years of age. Actually, most patients have no symptoms.
They may, however, experience occasional, vague right upper-quadrant abdominal
pain (below the rib-cage on the right side). This pain characteristically is
dull and aching, without a predictable pattern of occurrence. It is not an
intense, sudden, and severe pain, as might occur with, for example, gallstones.
The abdominal pain in NAFLD and NASH is thought to be due to the stretching of
the liver covering (capsule) when the liver enlarges and/or when there is
inflammation in the liver.
In contrast to ALD, HBV, and HCV, symptoms of severe, acute (rapid onset)
liver failure (due to intense hepatitis) are not observed in NAFLD or NASH. The
symptoms and signs of liver failure include yellowing of the skin (jaundice),
intense fatigue, loss of appetite, nausea, vomiting, and confusion.
The classic signs of insulin resistance dominate the physical exam in NAFLD
and NASH. As mentioned above, obesity (especially abdominal obesity) is the most
frequent finding. In addition, patients with long-standing DM2 may have
complications from the
diabetes, such as retinopathy (abnormal blood vessels in
the eye),
kidney (renal) failure,
and coronary artery heart disease. Elevated
blood pressure (hypertension) is frequent.
Acanthosis nigricans, a dark pigmentation of the skin of the armpits and
neck, can be a sign of insulin resistance and is frequently seen in children
with NASH. When the liver is palpated (felt by the doctor), it usually feels
normal. However, when very large amounts of fat accumulate in the liver, it can
be become quite large with a soft, rounded edge that can be easily felt by the
doctor.
The cirrhosis stage of NAFLD usually occurs later in life (age 50 to 60
years), presumably after many years of NASH. Frequently at this stage, patients
have insulin dependent DM2. (With ALD or HBV, in contrast, cirrhosis can
sometimes develop over a short period of time and, therefore, occur earlier in
life.) NASH patients with cirrhosis can be without symptoms (asymptomatic) if
diagnosed early. However, they can have typical signs of compensated or
decompensated cirrhosis.
The signs of compensated cirrhosis include a large, hardened liver, small,
star-shaped vessels (spider angiomata) on the skin of the upper torso, blotchy
redness on the palms (palmar erythema), whitened nails, thin silky hair, loss of
body hair, prominent veins on the abdomen (abdominal collateral veins),
irregular or absent menstruation in pre-menopausal women, and small testes and
enlarged, sometimes painful breasts (gynecomastia) in men. The signs of
decompensated cirrhosis include all the above except that the liver may be
shrunken and there may be swelling of the legs (edema), accumulation of fluid in
the abdomen (ascites), bleeding from veins in the esophagus (varices), and
mental confusion (hepatic encephalopathy).
Fatty liver has also been described in several medical syndromes (groupings
of abnormalities). For example, fatty liver occurs in polycystic ovarian
syndrome, in which polycystic ovaries are associated with obesity, excessive
hair (hirsutism), and insulin resistance. Congenital lipodystrophy syndromes,
which are rare disorders in which the fat in the torso and extremities shifts to
the abdomen, are also associated with an enlarged fatty liver.
Next: What are the complications of NASH? »
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